Tang Ching-Fang, Wu Mei-Yi, Wei Yau-Huei, Ho Yang, Kuo Ko-Lin
Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, ROC.
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2023 Oct 1;86(10):911-916. doi: 10.1097/JCMA.0000000000000980. Epub 2023 Aug 11.
Hemodialysis patients have a markedly increased risk of cardiovascular (CV) morbidity and mortality. Oxidative stress plays a pathogenic role in the progression of atherosclerosis and CV disease among chronic hemodialysis patients. The 8-hydroxy-2'-deoxyguanosine (8-OHdG) content in leukocyte deoxyribonucleic acid (DNA) has been shown as a sensitive and well-known biomarker of oxidant-induced DNA damage in chronic hemodialysis patients.
We conducted a retrospective cohort study to investigate the association of leukocyte 8-OHdG and CV events and deaths in patients of chronic hemodialysis. In this study, 217 chronic hemodialysis patients were recruited from 2016 to 2021. The 8-OHdG content of leukocyte DNA was measured by a high-performance liquid chromatography electrochemical detection method. Study outcomes were CV events as well as CV and all-cause deaths. The patients were followed until May 2021.
The median follow-up period was 34.8 months. At the end of May 2021, 57 first CV events and 89 all-CV events occurred. Among the first and all CV events, 17 (29.8%) and 32 (36.0%) were fatal, respectively. Multivariate Cox regression analysis showed per 1/10 5 dG increment in leukocyte 8-OHdG values increased risk of CV events (adjusted hazard ratio [aHR], 1.19; 95% CI, 1.10-1.41; p < 0.001), CV death (aHR, 1.27; 95% CI, 1.03-1.72; p = 0.034), and all-cause death (aHR, 1.11; 95% CI, 1.01-1.30; p = 0.038).
This is the first study to demonstrate that oxidative stress assessed by 8-OHdG levels of leukocyte DNA predicted CV events as well as CV and all-cause deaths among chronic hemodialysis patients.
血液透析患者心血管（CV）发病和死亡风险显著增加。氧化应激在慢性血液透析患者动脉粥样硬化和心血管疾病进展中起致病作用。白细胞脱氧核糖核酸（DNA）中的8-羟基-2'-脱氧鸟苷（8-OHdG）含量已被证明是慢性血液透析患者氧化应激诱导DNA损伤的敏感且知名的生物标志物。
我们进行了一项回顾性队列研究，以调查慢性血液透析患者白细胞8-OHdG与CV事件及死亡之间的关联。本研究于2016年至2021年招募了217例慢性血液透析患者。采用高效液相色谱电化学检测法测定白细胞DNA的8-OHdG含量。研究结局为CV事件以及CV死亡和全因死亡。对患者进行随访至2021年5月。
中位随访期为34.8个月。截至2021年5月底，发生了57例首次CV事件和89例所有CV事件。在首次和所有CV事件中，分别有17例（29.8%）和32例（36.0%）是致命的。多变量Cox回归分析显示，白细胞8-OHdG值每增加1/10 5 dG，CV事件风险增加（调整后风险比[aHR]，1.19；95%置信区间[CI]，1.10 - 1.41；p < 0.001），CV死亡风险增加（aHR，1.27；95% CI，1.03 - 1.72；p = 0.034），全因死亡风险增加（aHR，1.11；95% CI，1.01 - 1.30；p = 0.038）。
这是第一项证明通过白细胞DNA的8-OHdG水平评估的氧化应激可预测慢性血液透析患者CV事件以及CV死亡和全因死亡的研究。
